America's Future Prospects
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Please Note: This form will allow you to sign up for a Showcase Tournament or Showcase Team. Please fill in all information below, and click SUBMIT when finished to make payment.

CUSTOMER BILLING INFORMATION
     
First Name:    
Last Name:    

Address 1:

 

  

Address 2:

 

City:

 

  

State:

 

  

Zipcode:

 

    

Phone:

 

  

Email:

 

    

 

 

 
STUDENT ATHLETE INFORMATION

Please Fill this Section out with the Information about the student who will be attending the clinic

First Name:

 

  

Last Name:

 

  

Age:

 

    

Birthday:

 

          

High School:

 

  

 

 

 

Misc. Information:

  

 

 

 

WHICH CAMP/CLINIC WILL YOU BE ATTENDING

This is the amount your credit card will be charged. (Including Tax)

 

 

 
 

 

 

 
BILLING INFORMATION

 

 

 

Credit Card Type:

 

  

Credit Card #:

 

    

Name on Card:

 

  

Expiration Date:

 

      

3/4 Digit  CCV Code:

 

    

 

 
If you have any questions, please contact us at (631) 599-7952
 
 

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